无痛纤维支气管镜术诊治小儿呼吸道疾病92例临床分析

目的探讨和分析无痛纤维支气管镜术在诊治小儿呼吸道疾病中的应用价值。方法2003年1月至2005年1月，重庆医科大学附属儿童医院对原因不明的肺不张、反复或持续喘息、慢性咳嗽等小儿呼吸道疾病92例，男57例，女35例，年龄2个月至15岁，应用Olympus BF3c-20纤维支气管镜，在异丙酚无痛麻醉下进行病因检查和局部治疗。结果38例肺不张纤支镜术检查显示炎性狭窄、阻塞最多见，为18例(47.4%)；经局部灌洗、给药治疗，2周内复张率高达76.3%(29/38)。25例反复或持续喘息患儿，纤支镜术显示炎症所致分泌物阻塞、狭窄14例，气管-支气管软化、狭窄9例，细小异物2例，经局部灌洗给药治疗，获得较满意效果。29例慢性咳嗽中4例为支气管异物，19例为慢性支气管内膜炎，其他6例。92例患儿均采用异丙酚无痛麻醉，术中氧饱和度在0.90以上。结论儿科开展无痛纤维支气管镜术对肺不张、反复或持续喘息性疾病、慢性咳嗽等的病因诊断与治疗十分重要，对支气管细小异物的诊断有独特价值。异丙酚无痛基础麻醉下进行纤维支气管镜检术，使得操作更加容易，减少了风险，增加了安全性。

Application of non-pain bronchofibroscopy to the diagnosis and treatment of pediatric respiratory disorders.

To explore and to analyse the application of non-pain bronchofibroscopy to the diagnosis and treatment of pediatric pulmonary disorders difficult to diagnose.MethodsUnder general anesthesia of propofol,Olympus BF3c-20 bronchoscopy was used for pathogenesic examination and/or treatment of 92 cases from 2 months old to 15 years old with atelectasis of unknown origin,recurrent or prolonged wheezing and chronic cough.ResultsIn 38 cases with atelectasis,18 cases were found with inflammatory narrowness and stenosis(47.4%).After bronchoalveolar lavage and administration of drugs by bronchoscopy，29 cases were cured in 38 cases(76.3%).In 25 cases of recurrent and prolonged wheezing,14 cases were found with stenosis and mucus clog,9 cases with tracheobronchial softness,stenosis,2 cases with tiny foreign body.Optimal effect was acquired after bronchoalveolar lavage and administration of drug.In 29 cases of chronic cough,4 cases were caused by foreign body,19 cases by chronic endobronchialitis.92 cases were anesthesed through propofol and blood satuation was maintained over 90%.ConclusionNon-pain bronchofibroscopy is very important in pathogenesis diagnosis and treatment for atelectasis,recurrent or prolonged wheezing and chronic cough.And it has featured value in diagnosis for tiny foreign body.Bronchofibroscopy through non-pain propofol general anesthesia is a technique easy to perform,with decreased impair risk and with increased safety.